Dunn Winston, Shah Vijay H
Gastroenterology & Hepatology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Clin Liver Dis. 2016 Aug;20(3):445-56. doi: 10.1016/j.cld.2016.02.004. Epub 2016 Mar 28.
Alcoholic liver disease includes a broad clinical-histological spectrum from simple steatosis, cirrhosis, acute alcoholic hepatitis with or without cirrhosis to hepatocellular carcinoma as a complication of cirrhosis. The pathogenesis of alcoholic liver disease can be conceptually divided into (1) ethanol-mediated liver injury, (2) inflammatory immune response to injury, (3) intestinal permeability and microbiome changes. Corticosteroids may improve outcomes, but this is controversial and probably only impacts short-term survival. New pathophysiology-based therapies are under study, including antibiotics, caspase inhibition, interleukin-22, anakinra, FXR agonist and others. These studies provide hope for better future outcomes for this difficult disease.
酒精性肝病包括从单纯性脂肪变性、肝硬化、伴有或不伴有肝硬化的急性酒精性肝炎到作为肝硬化并发症的肝细胞癌等广泛的临床组织学谱。酒精性肝病的发病机制在概念上可分为：（1）乙醇介导的肝损伤；（2）对损伤的炎症免疫反应；（3）肠道通透性和微生物群变化。皮质类固醇可能改善预后，但这存在争议，且可能仅影响短期生存。基于新病理生理学的疗法正在研究中，包括抗生素、半胱天冬酶抑制、白细胞介素-22、阿那白滞素、法尼醇X受体激动剂等。这些研究为这种难治性疾病带来了更好的未来预后的希望。
